Early left ventricular ejection fraction as a predictor of survival after cardiac arrest
Barry Burstein1, Dev Jayaraman2, Regina Husa3
1a Division of Cardiology , McGill University , Montreal , Quebec , Canada.
Insights
Left ventricular ejection fraction (LVEF) after cardiac arrest does not predict survival. Echocardiograms are common, but LVEF over 40% is not a reliable indicator for patient outcomes post-resuscitation.
Area of Science:
- Cardiology
- Critical Care Medicine
- Emergency Medicine
Background:
- Cardiopulmonary resuscitation and early defibrillation improve cardiac arrest outcomes.
- The prognostic value of post-arrest left ventricular ejection fraction (LVEF) remains unclear.
Purpose of the Study:
- To investigate the significance of post-arrest LVEF on survival following cardiac arrest.
- To determine if LVEF > 40% predicts survival in resuscitated patients.
Main Methods:
- Retrospective cohort study of cardiac arrest patients (2009-2013).
- Included patients achieving return of spontaneous circulation (ROSC) and undergoing echocardiography within 24 hours.
- Primary outcome was survival.
Main Results:
- 97 patients underwent post-arrest echocardiography; mean LVEF was 35.7%.
- LVEF > 40% did not predict 30-day survival or hospital discharge.
- Age, shockable rhythm, and time to ROSC were significant predictors of survival.
Conclusions:
- Post-arrest LVEF > 40% is not a predictor of survival in patients resuscitated from cardiac arrest.
- Echocardiograms are frequently used, but LVEF has limited prognostic value in this context.
Background:
Cardiopulmonary resuscitation and early defibrillation have been shown to improve outcomes of cardiac arrest. The significance of the post-arrest echocardiogram, specifically the left ventricular ejection fraction (LVEF) is unknown.
Methods:
We performed a retrospective cohort study of patients who suffered from cardiac arrest between 1 January 2009 and 31 December 2013. We included all patients who achieved return of spontaneous circulation (ROSC), and were admitted to the intensive care unit (ICU) or coronary care unit (CCU) of a tertiary care academic center. Patients who underwent echocardiography within 24 h of cardiac arrest were included for analysis. The primary outcome was survival.
Results:
We identified 151 patients who achieved ROSC of which 97 underwent post-arrest echocardiogram within 24 h. 70.8% were males and the mean age was 67.8 years (SD: 15.9). The mean LVEF at 24 h was 35.7 (SD: 17.8). LVEF > 40% was not a predictor of survival at 30 days or hospital discharge. The only significant predictors on multivariate analyses were age, presence of shockable rhythm and time to ROSC.
Conclusion:
Although echocardiograms are frequently ordered, LVEF greater than 40% in patients who are resuscitated after a cardiac arrest is not a predictor of survival.
